Anxiety Impacts Consent Capacity to Treatment in Alzheimer's Disease.

This study aimed to clarify how behavioral and psychological symptoms of dementia (BPSD) and cognitive function affect the decision-making capacity of persons with Alzheimer's disease (AD) in a real informed consent situation about anti-dementia drug prescriptions. The participants were 76 patients with AD. We used the MacArthur Competence Assessment Tool to assess the capacity for consent to treatment (MacCAT-T). We simultaneously used the Mini-Mental State Examination, Executive Interview, Executive Clock Drawing Task, Logical Memory I of the Wechsler Memory Scale-Revised (LM I), LM II, and Neuropsychiatric Inventory (NPI) to assess cognitive function and psychiatric symptoms. We calculated the correlations between the MacCAT-T scores and the demographic, neuropsychological, and psychiatric variables. Once the univariable correlations were determined, we performed simple linear regression analyses to examine if the regression equations were significant. In the final analyses, we incorporated significant variables into stepwise multiple linear regression analyses to determine the most significant predictors of mental capacity. Age (ß = -0.34), anxiety (ß = -0.27), and LM I (ß = 0.26) were significant predictors of "understanding" (adjusted R 2 = 0.29). LM II (ß = 0.39), anxiety (ß = -0.29), and education (ß = 0.21) were significant predictors of "understanding of alternative treatments" (adjusted R 2 = 0.30). Anxiety (ß = -0.36) and age (ß = -0.22) were significant predictors of "appreciation" (adjusted R 2 = 0.18). Age (ß = -0.31) and anxiety (ß = -0.28) were significant predictors of explained variance in "reasoning" (adjusted R 2 = 0.17). Patients with anxiety had lower scores on all five MacCAT-T subscales: "understanding," without 3.8 [SD = 1.2] vs. with 2.6 [SD = 1.1]; "understanding of alternative treatments," without 2.9 [SD = 2.2] vs. with 1.3 [SD = 1.8]; "appreciation," without 2.9 [SD = 1.1] vs. with 1.9 [SD = 1.2]; "reasoning," without 4.0 [SD = 2.0] vs. with 2.7 [SD = 1.7]; and "expressing a choice," without 1.9 [SD = 0.4] vs. with 1.5 [SD = 0.6]. Considering the effects of BPSD, cognitive function, and age/education when assessing consent capacity in persons with AD is important. Reducing anxiety may contribute to improved capacity in persons with AD.

Greater than the Sum of Its Parts: δ can be Constructed from Item Level Data.

"δ", a latent variable constructed from cognitive performance and functional status measures, can accurately diagnose dementia. The minimal assessment needed is unknown. We have constructed a δ homolog, "dTEXAS", from Telephone Executive Assessment Scale (TEXAS) items, and validated it in a convenience sample of Japanese persons (n = 176). dTEXAS scores correlated strongly with both Instrumental Activities of Daily Living (IADL) (r = -0.86, p <  0.001) and Clinical Dementia Rating Scale (CDR) (r = 0.71, p <  0.001). Constructed independently of their diagnoses, dTEXAS scores accurately distinguished dementia versus controls (area under the receiver operating curve [(AUC; ROC) = 0.92], dementia versus mild cognitive impairment (MCI) (AUC = 0.80) and controls versus MCI (AUC = 0.74). These AUCs are higher than those of multiple observed executive measures, as reported recently by Matsuoka et al., 2014. A dTEXAS score of -0.58 best discriminated between dementia versus controls with 90.1% sensitivity and 80.0% specificity.

δ Scores are Exportable Across Cultural and Linguistic Boundaries.

The latent variable "δ", can accurately diagnose dementia. Its generalizability across populations is unknown. We constructed a δ homolog ("dT2J") in data collected by the Texas Alzheimer's Research and Care Consortium (TARCC). From this, we calculated a composite d-score "d". We then tested d's generalizability across random subsets of TARCC participants and to a convenience sample of elderly Japanese persons with normal cognition (NC), mild cognitive impairment (MCI), and dementia (AD) (n = 176). dT2J was indicated by Instrumental Activities of Daily Living and psychometric measures. Embedded in this battery were the Mini-Mental Status Examination (MMSE) and an executive clock-drawing task (CLOX). Only MMSE and CLOX were available in both TARCC and the Japanese cohort. Therefore, a second composite variable, "T2J", was constructed solely from the factor loadings of CLOX and MMSE on d. The diagnostic accuracy of T2J was estimated in the validation sample, the remainder of the TARCC cohort, and in the Japanese sample. The areas under the receiver operating curve (AUC; ROC) for T2J were compared in each sample, and against d in TARCC. The AUCs for T2J were statistically indiscriminable within TARCC, and in Japanese persons. In Japanese persons, AUCs for T2J were 0.97 for the discrimination between AD versus NC, 0.86 for AD versus MCI, and 0.79 for NC versus MCI. The AUCs for T2J in Japanese persons were higher than any individual psychometric measure in that sample. Valid d-score composites can be abstracted from a subset of δ's indicators. Moreover, those composites are exportable across cultural and linguistic boundaries.

Greater than the sum of its parts: δ Improves upon a battery's diagnostic performance.

OBJECTIVE: "δ", a latent variable constructed from batteries that contain both cognitive and functional status measures, can accurately diagnose dementia relative to expert clinicians. The minimal assessment needed is unknown. METHODS: We validated 2 δ homologs in a convenience sample of elderly Japanese persons with normal cognition (NC), mild cognitive impairment (MCI), and dementia (n = 176). The latent δ homolog "d" (for dementia) was constructed from Instrumental Activities of Daily Living (IADL) and Japanese translations of the Executive Clock-Drawing Task (CLOX), Frontal Assessment Battery (FAB), and Executive Interview (EXIT25). The latent delta homolog "d3" was constructed from a restricted set of d's factor loadings. RESULTS: d and d3 were highly intercorrelated (r = .97) and strongly related to both IADL and dementia severity, as rated blindly by the Clinical Dementia Rating Scale (CDR). d was more strongly related to IADL and CDR than any of its indicators. In multivariate regression, d explained more variance in CDR scores than all of its indicators combined. d's areas under the receiver operating characteristic curve (AUC) were 0.95 for the discrimination between Alzheimer's disease (AD) vs. NC, 0.84 for AD vs. MCI and 0.81 for NC vs. MCI. d3's AUC's were statistically indiscriminable. These AUC's are higher than any of d's indicators, as reported recently by Matsuoka et al. (2014), as well as the Mini-Mental State Examination (MMSE), which had been made available by Matsuoka et al. to the CDR raters. CONCLUSIONS: Latent variables can improve upon a battery's diagnostic performance and offer the potential for accurate dementia case-finding after a minimal bedside assessment.

Japanese versions of the executive interview (J-EXIT25) and the executive clock drawing task (J-CLOX) for older people.

BACKGROUND: The aim of the study was to develop the Japanese versions of Executive Interview (J-EXIT25) and Executive Clock Drawing Task (J-CLOX) and to evaluate the aspects of executive function that these two tests will be examining. METHODS: The concurrent validity and reliability of J-EXIT25 and J-CLOX were first examined in all participants (n = 201). Next, the relationship between the two tests was examined using receiver operating characteristic (ROC), correlation, and regression analyses in healthy participants (n = 45) and participants with mild cognitive impairment (n = 36) and dementia (n = 95). RESULTS: Satisfactory concurrent validity and reliability of J-EXIT25 and J-CLOX were shown. ROC analysis indicated that J-EXIT25 and J-CLOX1 were superior to the Frontal Assessment Battery, but inferior to the Mini-Mental State Examination (MMSE), in discriminating between non-dementia and dementia. J-EXIT25, J-CLOX1, and J-CLOX2 scores were significantly correlated with age, scores on the MMSE, Instrumental Activities of Daily Living (IADL) and Physical Self-Maintenance Scale (PSMS), and care level. In stepwise regression analyses of IADL scores, MMSE and J-EXIT25 were significantly independent predictors in men, and MMSE, age, and J-CLOX1 were significantly independent predictors in women. J-EXIT25, MMSE, and J-CLOX1 were significantly independent predictors in stepwise regression analysis of PSMS scores, and J-EXIT25 was the only significantly independent predictor in stepwise regression analysis of care level. CONCLUSIONS: J-EXIT25 and J-CLOX are valid and reliable instruments for assessment of executive function in older people. The present results suggest that these tests have common and distinct psychometric properties in the assessment of executive function.

Diagnostic performance of a combination of Mini-Mental State Examination and Clock Drawing Test in detecting Alzheimer's disease.

OBJECTIVE: Because of the growing need for quick cognitive screening tests to distinguish Alzheimer's disease (AD) from mild cognitive impairment (MCI), we compare the diagnostic performance of a combination of the Mini-Mental State Examination (MMSE) and a Clock Drawing Test (CDT) to the Japanese version of the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-J cog) in differentiating between patients with AD, patients with MCI, and healthy controls (HC). METHODS: Data from 146 subjects with AD and 60 subjects with MCI, as well as 49 HC, was retrospectively analyzed. We used logistic regression analysis with diagnosis as dependent variables and scores of the MMSE, the CDT-command, and the CDT-copy as independent variables, and receiver operating characteristic analysis to distinguish patients with AD from patients with MCI or HC. RESULTS: When patients with AD were compared to HC, the independent predictors of AD were scores on the MMSE and the CDT-command. This combination was more sensitive than the MMSE alone and has nearly the same sensitivity and specificity as the ADAS-J cog. When patients with AD were compared to patients with MCI, the independent predictors were the MMSE and the CDT-copy. This combination was more sensitive and specific than the MMSE alone and was almost as sensitive and specific as the ADAS-J cog. CONCLUSION: The combination of the MMSE and the CDT could be a powerful screening tool for differentiating between patients with AD, patients with MCI, and HC. Its sensitivity and specificity are comparable to ADAS-J cog, which takes more time.